Face presentation

1.

Face presentation
KARTIK KASHIV
GROUP NO.163 B

2. Definition

Head hyper extended, with face as
presenting part

3. Epidemiology

Incidence: 0.1 to 0.2% of singleton
deliveries

4. Pathophysiology

Face presentation is an extended
attitude
• Results in largest head diameter:
Occipitomental
• Increases diameter 3 cm (24%) over
flexed head

5.

6. Causes

Polyhydramnios
Multiple pregnancy
Multiparity,lax uterus
Contracted pelvis

7. Cont.

Anencephaly
Loops of cord around the neck
Tumours in front of neck, cystic
hygroma, goitre

8. Diagnosis

During pregnancy
High head
Head protuberance on the same side as
the back
USG
In labour
Mouth, jaws, nose,alveolar and orbital
ridges are felt

9.

10.

Labour in face presentation
Prolonged labour
Early ROM
Perineal & vaginal tears
May end in obstructed labour due to
mentoposterior or mentotransverse
position

11. Management

Do not attempt to convert face presentation
to vertex
Never apply vacuum extractor to face
Do not apply internal scalp electrodes
Avoid Oxytocin in most cases
Consider large episiotomy if fetus delivers
vaginally

12. Management

No active intervention
Wait for the spontaneous rotation and
delivery
Epidural analgesia
If prolonged second stage and mentoanterior :apply forceps

13. Cont.

If persistant mentotransverse:
rotation manually or with Kielland
forceps
In persistant mentoposterior:
C.Section

14.

Brow Presentation

15. Epidemiology

Incidence: 0.02% of singleton deliveries
Brow is an area between the orbital
ridges and anterior fontanelle
• Results when head is halfway between flexion &
extension

16.

17.

18. Diagnosis

Never made during pregnancy
In labour
High head
Frontal suture & anterior fontanelle on one
side and orbital ridges on other side

19. Pathophysiology

• Results in largest head diameter:
Occipitomental (mentovertical )13.5cms

20. Management

Cesarean section required in most cases
Brow presentation rarely can deliver vaginally
unless:
• spontaneously converts to vertex or face
presentation
• fetus is very small or pelvis is very large

21. Cont.

Do not attempt to convert brow
presentation to vertex
Never apply vacuum extractor to brow
presentation
Do not apply internal scalp electrodes
Avoid Oxytocin